HomeMy WebLinkAboutBuilding Permit #513 - 224 HAY MEADOW ROAD 4/1/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ''
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Permit NO: Date Received pDRA7ED (y
- � ��SSACHU`���
Date Issued:
IMPORTANT: Applicant must complete all items on this naize
LOCATION 2Z--1-( 14,814 meAOcL-1 ZoA--eg
Print
PROPERTY OWNER G r 2 M P /Z le- S A -,*7J
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shoo Villaae ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential .
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
a 4 1(64 C� J' �'�vn �4— 1"
Identification Please Type or Print Clearly)
OWNER: Name: 601Zz j /,q/41z4- E,,qrnrE Phone: S'� -(,fir-
Address: .1 Z Y /-E11+`/ M (�' f n Gw l.clollt p
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:-
ARCHITECT/ENG I NEER
ate:
ARCHITECT/ENGINEER
Address:
Phone:
Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ S�;-�0®U FEE: $ TOO
Check No.: S �% Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to t guaranty
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
PLocation 0� c' c� �e✓�
13 Date
Na r
MORTh TOWN OF NORTH ANDOVER
Of No r•,tiG
' • OL
9 '
Certificate of Occupancy $
s�CMUs <� Building/Frame Permit Fee $ d �'
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 990
Building Inspector
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Liam Colleran
52 Dalton Road
Concord MA 01742
MA Const Sup Lic. # 082944
April 1, 2009
Lori & Mark Samse
COLLIERAN CONSTRUCTION ice (978) 369-1488
224 Hay Meadow Road
North Andover, MA 01845
Dear Lori & Mark,
GIENFRAL CONTRACTOR
224 Hay Meadow Road
Kitchen Renovation
Mobile (978) 502-5497
Liamconstruction@verizon.net
MA HIC Reg. # 137740
Thank for the opportunity to present you with this quote to renovate your kitchen. This
proposal is based on our meetings and the plans you provided me from Kitchen Works.
As discussed our work will be limited to the kitchen and great room area of you home.
All existing kitchen cabinets, counter tops and appliance will be removed and disposed
of. Additionally, the existing flooring in both the kitchen and great room will be
removed and prepped for the installation of hardwood.
Following the install of the new flooring all cabinets, counter tops and appliances will be
installed. New outlets and lighting will be added as per the kitchen design plan.
The engagement will be billed on a time and materials basis. Billing will occur at the
completion of each phase of the project., ie at the end of demo, flooring, wiring and
cabinet install. The affected areas will be painted at the conclusion of the project.
The following are a list of exclusions from the work proposed.
➢ Cabinets, counter top / installation
➢ Appliances
➢ Sinks, faucets
➢ Tile
f, Liam Colleran COLLERAN CONSTRUCTION Office (978) 369-1488
52 Dalton Road GENERA. CONTRACTOR Mobile (978) 502-5497
Concord MA 01742 Liamconstruction@verizon.net
MA Const Sup Lic. # 082944 MA HIC Reg. # 137740
If you have any question or comments, please do not hesitate to call me at either (978)
369-1488 (office) or (978) 502-5497 (mobile). I look forward to working with you in the
future.
Sincerely,
Liam Colleran
Accepted and Agreed:
vu� Date:
Lori & Mark Samse
• By signing the above you accept the terms of the General Information
section of this agreement
• Proposal valid for 30 days from date of issuance
• Once accepted, any changes to this proposal must be in writing.
- y -
1 d. EiDE91 Z{DEM DEDEM 9
0 -
Liam Colleran COLL AN CONSTRUCTION- Office (978) 369-1488
52 Dalton Road GENE REAL CONTRACTOR Mobile (978) 502-5497
Concord MA 01742 Liamconstruction@verizon.net
MA Const Sup Lic. # 082944 MA HIC Reg. # 137740
General Information
➢ All Home Improvement Contractors shall be registered and any inquiries about a
contractor should be directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place, Room 1301
Boston, MA 02108
Telephone, 617-727-8598
➢ Unless otherwise stated in this document, the contract shall not imply that any lien
or other security interest has been placed on the residence.
➢ Owner has a three-day cancellation right under MGL chapter 93 section 48. This
cancellation must be in writing.
➢ In signing the construction agreement, you have verified and understand the terms
outlined in this General Information section.
➢ Only items specifically mentioned in the construction agreement are included in
the project.
➢ Owner must ensure that the space where the work is being preformed is free and
clear of personal belongings prior to the start of the engagement. This includes
any pictures, mirrors or shelving hanging on adjacent walls.
➢ Newly constructed areas, such as additions, basements, garages, etc. will not be
used for storage of homeowner items or use until after the final building
inspection.
➢ Contractor is responsible for the work (and its associated subcontractors) outlined
on this proposal only. It is not the responsibility of the contractor to coordinate
access to the property for other work / contractors who may be workingat t the
residence and are not working for the contractor.
➢ Contractor will not be responsible for project delays that may result from the
delay in delivery of items not ordered by contractor. Any delay beyond two days
will be billed at the current daily rate.
➢ Homeowner will be aware that changes in project scope, once the project has
begun may result in an extended project timeline.
Liam Colleran COLLERAN CONSTRUCTION ice (978) 369-1488
52 Dalton Road GENERAL. CONTRACTOR Mobile (978) 502-5497
Concord MA 01742 Liamconstruction@verizon.net
MA Const Sup Lic. # 082944 MA HIC Reg. # 137740
➢ It is the responsibility of the homeowner to verify the completeness of items that
they purchase directly. (For example: bath accessories, tile quantities, roof
shingle color)
➢ Items ordered and purchased by the homeowner will not be under warranty by the
contractor.
➢ It is the responsibility of the homeowner to avail themselves for scheduled service
repair of items purchased directly by the homeowner. If the homeowner is not
available and would like the contractor to be available for a scheduled service
call, the contractors hourly rate will be charged during the service period.
➢ Dumpsters: Dumpsters are for construction debris only. Homeowners and
neighbors are not to place items in dumpsters without approval from contractor.
If overweight or volume charges are incurred due to items other than construction
debris, charges will be passed to homeowner.
➢ Work is scheduled on a first come / first serve basis. Verbal commitment to a
project is not a guarantee to be scheduled for work. Only the receipt of a deposit
check will secure the scheduling of work. Once the deposit is received, the
customer will be placed in the next available slot for work to begin.
➢ Electrical assumptions: Unless otherwise stated, pricing for engagements is based
on a lighting assumption that Halo brand H7ICTH recessed ceilings lights will be
installed. If recessed lighting is different, the incremental additional pricing will
be billed to the homeowner. Additionally all switching and other electrical
devices are assumed to be standard toggle switches (toggle switched dimmers) or
standard duplex outlets. Low voltage, Decora or colored Decora devices will be
billed at incremental additional pricing.
➢ Time and Materials fees: Time and materials (T&M) will be billed to the
customer in the event a fixed price for a project or a subcontractor has (have) not
been established. If the contractor is secured on a time and materials basis, the
customer will be billed for the time working at a predetermined hourly rate and
the materials will be billed at cost plus 20%. If a subcontractor is billed on a time
and materials basis, the customer will pay the contractor, the subcontractors fee
plus 20%. A T&M number quoted as not to exceed, will include 20%. Time and
material fees will be billed upon the completion of the task.
➢ Please make all change order requests to the general contractor not to the
subcontractors.
➢ Change orders: ANY changes — regardless of how minor - to this proposal,
beyond its scope of work, need to be made in writing. This includes any
changes as a result of unforeseen conditions, such as faulty wiring or water and
Liam Colleran COLLMN CONSTRUCTION Office (978) 369-1488
52 Dalton Road GENFRAI CONTRACTOR Mobile (978) 502-5497
Concord MA 01742 Liamconstruction@verizon.net
MA Const Sup Lic. # 082944 MA HIC Reg. # 137740
insect damage, which may require immediate attention. All change orders will
result in additional project fees.
A Change orders will be invoiced prior to the completion of the change order.
A Milestone pricing and payments: Billing dates are based on milestones met
during the project. Payment is expected upon meeting the milestone. The
contractor will make every effort to alert the homeowner as a milestone is being
approached. If a post dated check is issued, work may discontinue until the date a
post-dated check may be deposited and has cleared.
A Any change order (which does not impact the scope of work) requested beyond
the immediate scope of work (eg. Kitchen sink repair while bathroom remodel is
in progress.) shall be handled at the conclusion of the project and will be invoiced
separately.
A Allowances / Budget Number: Many of the items listed on this proposal are listed
as "allowance" items. This means that a certain dollar amount has been set as an
allowance for each of these items.
The price shown on this proposal represents what I expect my cost of the item to
be plus 20%. If the actual cost of the allowance item is less than the allowance
price listed, the client is entitled to 100% of the difference between the allowance
and the actual cost of the item. The item will then be invoiced for actual cost plus
20%. If the client chooses options or additional work that total more that the
allowance figure listed, the client will pay the contractor's cost for the item, plus
20%. All such adjustments will be handled as change orders to the contact.
Allowance items purchased directly by the homeowner, will be invoiced 20% of
the purchase price.
Boa if8u°i��ng�6 and tan aw,%
HOME IMPROVEMENT CONTRACTOR
Registration:. 137740
Expiration: InJ2011 Tr# 280612
Type .DBA
COLLERAN CONSTRUCTION
WILLIAM COLLERAN-1111
52 DALTON RD.�
CONCORD, MA 01742 Administrator
Massachusetts- Dcpartment cit• Puhlic Safct�
IV, I.rua�d-zlf Building. Rea-ulations and Standards
--.0onstruction Supervisor License
License: GS 82944.
Restricted to: 1 G'
WILLIAM E COLLERAN
52 DALTON RD
CONCORD, MA 01742 _
Exlii anon: 6/26/2010
{'ommissinner Tr#: 30255 `
The Commonwealth ofHiusachusetts
l o Department
f Industriol1Qccidenis
'i ii �t Lr i DJ✓ LCe of Inve,76g tions
600 Washins�
on Street
Boston MA 0111
r wwKt. maSS-, ov/dia
Workers Compensation Insurance.Affidavit: guilders/Co
Ispficant Informatntractors/Elecirici$ns/Piumbers
ion
Please Print Lt�oihi
Name (Business/OrganizationMdivi dual):
Address:
City/Statelzip: r% GGYZ yrn14Phone #: - 3
Are you an employer? Check the appropriate box:
1.❑ I and a employer with
4. ❑ f am a general contra„^tor
Type of project (required):
employees (full and/or part-time).*
and I .
have hired the sub -contractors
6•. ❑ New construction
2
//
1 am a sole proprietor or partner-
\\ ship have
Iisted ori the attached sheet. $
?.❑ RernodeI:c .
b
and no employees
working for me in any capacity.
These Sub-cantr�actors have
workers' comp. insurance.
8. ❑ Demolition
[No workers' comp. insurance
5- ❑ We are a corporation and its
9• ❑ Building addition
3. ❑required_]
I am a homeowner doing all
officers have exercised.their
10:❑ Electrical repairs or additions
work
myself. [No. workers' comp,
right of exemption per MGL
c• 1S2, 1(4): and we have no
and.
1 l.❑ Plumbing repairs or additions
insurance required.] t
employees. [No
12'❑ Roof repairs
*Anv
comp, insurance required_]
13.E]Other
applicant,thar checks box # 1 .must aiso'fill out the
t iiomcowuers wire submjt •fltjs al— inciicatin, iitei
IContlactors
section below showing ih- r workers' compensation polic}
Bic %ulIi- lei fi%:I'f SYt(I
information.
then iij Gl[taiilE COt1V&CIUfs' Itlllji yltblitj(a new am¢avlL indicating
that eileak this box.mu t attached an additional sheet showing tate name .of the sub ';.:ch,
!air as emploper that is providing workers'
information
-con tactors end their
cnrrtperrsation insurance or r
fp
waricels' comp, poijc} jnionnation,
employees.
Below is the oft cJ and Job site
Insurance Company Name:
Policy # or Self .ins. Lic. #:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a Copy of the workers' compensation policy declaration page (showitt; the policy Dumber and expiration date).
Failure to secure coverage as required under Section 25A of MGL C. 152 can
finlead to the imposition of criminal penalties of a
e up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of e DIA for insurance coverage verificati.otl.
I do herebJi cc
fy under the p p
ZZ7
that the inforinafian provided above is true and correct
Simature:17
Date: y �( o 9
Phone #: v 3 C 1; -/ 4/ a o
Official
use anly. Do not write in this area, to be completed by city or town ofcial
Town: Permit/License #
Authority (circle one):
of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PlumbingInspector
r
t Person:
Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined. as "..wer-y person in the service of another under any contract ofhire,
express or implied; oral or written."
An employer is defined as "an inaividual, partnership; association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the Ie4al representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, associati on or other legal entity, employing employees. However the
owner of a dwelling house having not more than .three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance; construction or repair work on such dwelling house
or on the grounds or building appurte-mant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state c> r local licensing agency shall withhold the issuance or
renewal of a license or permitto operate a business or to construct building in the commonwealth for -any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither -the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public wor% until acceptable evidence of compliance with the insurance
requirements of -this chapter have been presented to the coritmcfing authority," .
Applicants
Please fill out the workers' compensation affidavit compl<-eteiy, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certincate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other, than the
members or partners, are not required to cany.workers' compensation insurance. Ifan LLC or LLP does have ..
employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the. affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regi Tiling the -lam, or if you amr required to obtain a workers'
compensation policy; please call the Department at the nQanbur:listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed lee�biy. The Department has provided a space at the bottom
of the affidavit foryou to fill but in the event the Office of Investigations has to contact you regarding the appiicant:
Please be sure to fill in the permitfiicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in arty given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Adclr-ess" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each
year. 'Where a home owner or citizen is obtaining a Iicens� or permit not related to any business or commercial venture
(i.e. a dog license or permit to burnleaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to -thank you. in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of lmdustrial Accidents.
4fce of fitvestigaticoas
600 'Wach ington Street
Briton; MA G2111
Tel. # 617-727-4900 e= 406 c r 1-977-MASSAFE
Revised 5-26=05
Fax 4 617-7-7-7749
uW%1.tnass.gov/dia